Laserfiche WebLink
/8 <br />APPLICATION CHECKLIST <br />rii <br /> <br />~ rint~riiriii ~~~ <br />REGULAR 1 12 APPLICATION NAME ,['~~ ,~~.F I LE #8-37 iY,C <br />- i <br />COMPLETE F I LED) DATE t/~~L, y>~ / y $'O <br />ITEM CDMPLETE ADEQUATE COMMEN75 <br />Application Form: <br />1. Name of operation <br />lj~ <br />2. Name of appiicant ~/~ <br />3. Address b phone, local C~- <br />4. Address s phone, general c.~ <br />5. Person to contact C' <br />o. Parent Corporation, if any ~, <br />7. Surface Owners v, <br />8, wineral Cwners <br />v <br />9. Source of Legal Right-to-Enter ~ <br />10. 'ype of Mine/Substance ~~- <br />11. General Location & Elevation ~_ <br />iZ. County ~~- <br />13• Acreage ~. <br />14. Fae ~! <br />15• Present Land Use LJ. <br />16. Surrounding Land Uses l.~ <br />17. Proposed Future Use ~, <br />i8. Unpermitted Mining Operations ~ <br />19. A;fected Lands l/ <br />?0. Signature ~.i-l_ <br />(over) <br />